Provider Demographics
NPI:1578764817
Name:COMPREHENSIVE CARDIAC CARE,INC
Entity Type:Organization
Organization Name:COMPREHENSIVE CARDIAC CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-496-7900
Mailing Address - Street 1:5258 LINTON BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6540
Mailing Address - Country:US
Mailing Address - Phone:561-496-7900
Mailing Address - Fax:561-496-6825
Practice Address - Street 1:5258 LINTON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6540
Practice Address - Country:US
Practice Address - Phone:561-496-7900
Practice Address - Fax:561-496-6825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50715207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51089Medicare UPIN
FL04714Medicare PIN